Nail Pitting

What is nail pitting?

Nail pitting is when small dents, holes or grooves form in your fingernails or toenails. This makes your nails look uneven or bumpy instead of smooth.

Sometimes, if you hurt your finger, the top part of your nail (called the nail plate) might look rough for a while. That kind of damage usually heals as your nail grows out. But nail pitting is different. It’s not caused by an injury. The dents keep showing up in new nail growth. It can change how your nail looks and feels.

Nail pitting is often a sign of another health condition, like nail psoriasis. There are treatments that can help manage the cause.

What do pitted nails look like?

Your nails might look like they have tiny pinpricks or deeper dents. They won’t be smooth. This can happen on just one nail or several. Sometimes, you might have only a few small pits that are hard to see. Other times, you might have a lot, making your nails look like the surface of a thimble.

What other symptoms happen with nail pitting?

Nail pitting is usually one of the first signs of nail psoriasis. Other changes to your nails may happen, as well. You might notice:

• Blood under your nail
• Buildup under your nails
• Cracking or crumbling nails
• Nail discoloration
• Nails lifting away from your fingers or toes
• Pain or tenderness under your nail

You may also feel embarrassed or self-conscious about how your nails look.

A healthcare provider can help figure out what’s causing these changes and recommend the right treatment.

What are the most common causes of nail pitting?

The most common causes of nail pitting are psoriasis and psoriatic arthritis. About half of all people with psoriasis will have nail problems at some point in their lives.

Other health conditions can also lead to nail pitting, including:

• Autoimmune diseases like alopecia areata, sarcoidosis or pemphigus vulgaris
• Genetic conditions like incontinentia pigmenti
• Reactive arthritis (also known as Reiter’s syndrome)
• Skin conditions like eczema or dermatitis

Nail pitting can happen to anyone at any age, but it’s more common after age 40.

Do vitamin deficiencies cause nail pitting?

A vitamin deficiency doesn’t cause nail pitting. However, low levels of iron or zinc can lead to other nail problems, like Beau’s lines (horizontal ridges or dents) or spoon-shaped nails.

How doctors diagnose nail pitting

A healthcare provider can usually diagnose nail pitting by looking at your nails. They’ll also ask about your medical history and any other symptoms you might have.

To find out what’s causing the nail pitting, your provider may order additional tests, like:

• Blood tests
• Skin biopsy

Nail pitting treatment

To treat nail pitting, your healthcare provider will focus on the cause. Nails are often hard to treat with topical medicines alone. Your provider may suggest using both topical and oral medicines together, which could include one or more of the following:

• Apremilast: Helps control nail changes and other psoriasis symptoms
• Biologics: Improve nail and skin symptoms caused by psoriasis or psoriatic arthritis
• Calcipotriol: Clears buildup under or around your nails
• Corticosteroids: Reduce pitting, thick nails and buildup under your nails
• Cyclosporine: Reduces serious nail problems by calming your immune system
• Methotrexate: Treats nail damage and swelling in more serious cases
• Retinoids: Fix thick, rough or damaged nails from psoriasis
• Tazarotene: Treats pitting, nail lifting and changes in nail color

These medicines may come as skin creams, pills or shots (injections). You may need more than one treatment. It can take a few months to see results because nails grow slowly.

Other treatments may also help, depending on your symptoms and how well the medicine works for you. Your provider will help you choose the best plan.

What can I do at home to treat nail pitting?

There’s no cure you can do at home to get rid of nail pitting. But if you have psoriasis or another skin condition, taking good care of your nails can help keep them as healthy as possible. Try these tips:

• Avoid manicures, fake nails and nail polish, which can irritate your nails
• Don’t cut or push back your cuticles
• Follow your treatment plan as your provider recommends
• Keep your nails short to prevent breaking or splitting
• Wash and moisturize your hands and nails
• Wear gloves when washing dishes, cleaning or using chemicals

What are the possible risks of not treating nail pitting?

Nail pitting isn’t dangerous on its own, but it’s still important, and you shouldn’t ignore it. Because it’s usually a sign of another condition, it could get worse over time if you don’t treat it. In some cases, you could lose part or all of your nail.

When should nail pitting be treated by a healthcare provider?

Even though nail pitting isn’t serious, you should still let your healthcare provider know if you notice it or other changes in your nails. It’s important to find out the cause of the problem and get the right treatment to help manage it.